Olfat A. Darwish and Ezzat K.
Amine High Institute of Public Health, University of Alexandria,
Alexandria, Egypt

Sabiha M. Abdulla
University of Basrah, Basrah, Iraq

INTRODUCTION

It is well recognized that both prevalence and duration of
breast-feeding in most parts of the world is undergoing an
overall decline. Reports by Mönckeberg (1), Bender et al. (2),
and Ridley (3) indicate that the trend away from breast-feeding
began as early as the 1940s in developed countries, and a few
decades later in developing countries. Evidence was provided by
Gopalan and Naidu (4), Brown (5), Jelliffe (6), Barvazion (7),
Hendershot and Hirschman (8), and Deitch (9) that socioeconomic
development, particularly the level of education of the mother,
was the major factor affecting breast-feeding patterns. According
to Buchanan (10) and Van Ginneken (11), breast-feeding lasts for
an average of tvvo to six months in developed countries and in
urban areas of developing countries. In rural areas of developing
countries, breast-feeding lasts for 18 to 24 months and the
infant is fed on demand. The most common limitations to the
length of lactation in developing communities were the onset of a
second pregnancy and isufficiency of breast-milk.

Age at start of supplementation of breast-feeding, type of
diet, and age of weaning vary-widely in different communities. in
Iraq, Gounelle and Demarchi (12), Demarchi et al. (13), and Zaki
(14) reported that supplementation occurs at seven to 12 months
with cereals, vegetables, milk, and eggs.

In rural Africa. Jelliffe (15) reported that supplementation
with bone marrow and pre-chewed meat is given as early as the
third month after birth, while Careal (16) reported that infants
at the age of five to six months were supplemented with porridge
made of cassava paste and sugar, and at the age of 10 to 12
months the infant changed to an adult diet. In Egypt, Darwish et
al. (17) and Kamal et al. (18) showed that weaning may start
before the sixth or at about 18 months, with an average age of
weaning of 15 months.

OBJECTIVE AND METHODS

The aim of this study was to investigate the infant feeding
patterns in Iraq. A sample of 218 mothers attending MCH centres
at Basrah Governate were included. The mothers were interviewed
during their visits to the centres, according to a pre-planned
questionnaire. The data obtained during the interview included
breast-feeding and weaning practices, socio-economic variables
(including monthly income, education of fathers and mothers,
occupation of both mother and father, type of family, and housing
conditions). Using these variables, the investigators classified
the mother into three social levels (Table 1).

RESULTS

Socio-economic characteristics of a community affect infant
feeding practices in terms of the length of time an infant is
fully breast-fed, age at which replacement of milk by other
dietary sources takes place, and the types of diet used to
supplement or replace mother's milk. The data obtained in this
study show the impact of social class on infant feeding practices
in southern Iraqi communities, as shown in Table 2. The duration
of full lactation was inversely related to social class. Mothers
in higher socioeconomic levels started bottle and supplementary
feeding earlier than mothers in the other two levels. The mean
lenght of full breast-feeding for infants in the higher social
class was 3.8 months, while the same period for the low social
class was 4.7 months. Infants in the middle class were bottle-fed
later than lower social class infants at 4.9 months. The
difference between high and low social class was significant (P
<0.05).

TABLE 1. Distribution of Levels and
Scores of Social Class Index

High

Middle

Low

Level

Score

Level

Score

Level

Score

Monthly
income

ID
45+

30

30

20

30

15

Education
of father

12+yrs.

10

9

8

6

5

Education
of mother

12+yrs.

10

9

8

6

5

Occupation
of father.

Group
A

10

Group
B

8

Group
C

5

Occupation
of mother.

Group
B

10

Group
B

8

GroupC

5

Family
type

Simple

20

Compound

10

More
than F

5

Housing

10

8

5

Group A: Professional
Group B: Clerical, businessman, skilled worker
Group C: Farmers' labourers, unskilled worker
Total score for high social class equals 80+, for middle class
equals 50, and less than 50 for low social class.

The distribution of mothers
according to social class and age of infant at weaning is shown
in Table 3. Mothers of high social class started weaning their
infants before the age of three months, the low social class
delayed weaning to 18 months, while mothers from the middle
social class started weaning at an age in between. An appreciable
proportion of high social class mothers weaned their infants at
six months of age. About two-thirds of middle class mothers
weaned their infants before the end of the first year of life,
while most of the infants of low-income mothers were weaned at
the age of 12 to 18 months. The difference in distribution was
statistically significant: x²12 = 37.08, p <0 05.

Table 4 presents the distribution
of the mothers according to social class and reason for weaning.
The main reason in the high social class was that mothers were
working. In the middle and low social classes, the reasons were
"insufficient milk" and the child's being "old
enough". The differencebygroupswassignificant: x²6 =38.9,p<0.05.

TABLE 2. Mean Duration of Full Lactation and Age in
Months at Start of Supplementary Feeding. by Social Class

Infant feeding practices of the
mothers involved in this study were affected by their social
status, which is a common characteristic in most developing
countries, as reported by Shakir et al. (19) in Iraq, Zaghloul
(20) in Egypt, Awadh (21) in Bahrain, and Huffman et al. (22) in
Bangladesh.

TABLE 3. Distribution of Mothers According to Social
Class and Age of Infants at Weaning

Age at
Weaning

Social Class

Total

High

Middle

Low

No.

%

No.

%

No.

%

No.

%

Less
than 3 months

7

11.3

1

1.14

6

8.8

14

6.4

3

15

24.2

15

17.0

8

11.8

38

17.4

6

22

35.5

28

31.8

18

26.5

68

32.1

9

2

30.2

11

12.5

5

7.4

18

7.3

12

12

19.3

18

20.5

9

13.2

39

17.9

15

2

3.2

2

2.3

5

7.4

9

4.1

18

2

3.2

13

14.8

17

25.0

32

14.8

Total

62

100.0

88

100.0

68

100.0

218

100.0

Mean
age at weaning

8.04±4.5

10.5±5.0

11.3±6.2

10±5.4

TABLE 4. Distribution of Mothers According to Social
Class and Stated Reason for Weaning

Social Class

Total

High

Middle

Low

Reason
for Weaning

No.

%

No.

%

No.

%

No.

%

Insufficient
milk

19

30.6

39

44.3

25

36.8

81

37.2

Child
old enough

15

24.2

31

35.2

23

33.8

71

32.6

Subsequent
pregnancy

3

4.8

13

14.8

17

25.0

33

15.1

Mother
out to work

25

40.3

5

5.7

3

4.4

33

15.1

Total

62

100.0

88

100.0

68

100.0

218

100.0

TABLE 5. Distribution of Mothers According to Social
Class and Types of Food Given as Supplementary Feeding

Social Class

Total

Types of food

High

Middle

Low

No.

%

No.

%

No.

%

No.

%

Rice

1

1.6

14

16.0

23

34.0

38

17.0

Bread

1

1.6

14

16.0

17

25.0

32

15.0

Lentil
soup

1

1.6

4

4.5

4

6.0

9

4.0

Fruit
juice

19

30.6

16

18.0

2

3.0

37

17.0

Egg

8

13.0

11

12.5

2

3.0

21

10.0

Yoghurt

4

6.5

4

4.5

3

4.0

11

5.0

Cerelac

22

35.4

12

13.6

3

4.0

36

17.0

Others (chick peas and family
diet)

6

9.7

13

15.0

14

21.0

33

15.0

Total

62

100.0

88

100.0

68

100.0

218

100.0

The most important considerations
in supplementary feeding of any group of infants and children
seem to be age at which it is begun, what types of food are
given, and how economic position may affect the kind of food a
child receives.

The kind of weaning foods given
to a child is affected by social class. Rice, bread, and the
family diet are the main supplementary foods given to babies who
belong to the lower social class. These foods are bulky, low in
energy density, and poor in protein quality compared to the
proteinrich foods and fruit juice given to babies in the higher
class.

For Islamic populations, the
Koran prescribes that mothers should nurse their children for two
whole years. Compliance with this law was investigated by asking
the mothers involved in this study about their past experience
regarding weaning practices. It was found that this rule in most
instances was overlooked, and infants were completely weaned
before the end of the first year.

Early weaning is common practice
in developed countries, and, where socio-economic standards are
high, decrease in breast-feeding does not provoke
under-nutrition, but in less developed countries it surely does.
This is because of the unfavourable environment in developing
communities where many factors interact to the disadvantage of
the weaned infant. Adoption of early weaning practices in
developing countries following the pattern in developed countries
is still the major cause of the serious nutritional and health
problems in infancy.